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Amanda Hickman first noticed it when her daughter, Aubrey, was 9 months old.

Aubrey’s right eye turned in slightly when she tried to focus while being fed in her high chair.
Her mother mentioned it the next time she took Aubrey to see her pediatrician.

That led to a comprehensive exam by an eye doctor, who found that the Westerville infant was
very farsighted. After Aubrey was fitted with glasses, “she looked at me as if she was seeing me
for the first time,” Hickman said.

The diagnosis also led to the discovery that Aubrey’s older brother, Caleb, also needed glasses
for a similar vision problem.

Hickman, who taught elementary school before becoming a stay-at-home mom, feels that her
children — now 22 months and 3 years old — might have had developmental delays had their
farsightedness gone undetected.

“I’m so thankful I got them diagnosed now,” she said.

But eye doctors have different views on how best to detect vision problems in young children
like Aubrey. Optometrists say that only a comprehensive eye exam by an eye doctor will do.

Many ophthalmologists prefer that children be screened by their pediatrician by the time they’re
6 months old and then undergo an eye exam with a pediatric ophthalmologist only if a problem is
identified.

But that arrangement, even some ophthalmologists admit, has resulted in underdiagnosis of eye
problems in children, in part because pediatricians often lack the time and training to do a
thorough exam. As a result, more than 100,000 U.S. children are expected to have permanent vision
loss because intervention for their vision problems didn’t come soon enough, said Dr. David G.
Hunter, an ophthalmologist and clinical spokesman for the American Academy of Ophthalmology.

Hunter said the solution is developing better tools to help pediatricians better determine when
referrals are necessary. He has founded a company, Rebiscan, that’s working to develop a pediatric
vision scanner that he hopes will do just that.

Optometrists, meanwhile, encourage parents to use the InfantSEE program to get free eye exams
for their children when they are 6 months to a year old. Optometrists — licensed medical
professionals who did not go to medical school — performed at least 1,095 such assessments in Ohio
in 2012, more than in any other state. That’s probably an undercount because some optometrists
probably don’t submit documentation of an exam. Still, it represents less than 1 percent of the
eligible infant population in Ohio.

Some ophthalmologists have criticized the InfantSEE program, calling it a way to generate
business for optometrists, who have fought to expand the scope of eye care they can legally provide
nationwide. In most states, including Ohio, optometrists are not permitted to perform eye surgery,
for example.Ophthalmologists also have been critical of laws in states that require all children to
get an eye exam before they start school. “That is what I consider too much, too late,” Hunter
said.

Optometrists say the InfantSEE program has clinical guidelines and can help catch children’s
vision problems that might otherwise go undetected.

Early diagnosis of amblyopia — commonly known as “lazy eye,” and thought to affect 1 to 4
percent of children — can make it easier to correct, said Dr. Michael Earley, assistant dean for
clinic services at Ohio State University’s College of Optometry. Later in their childhood,
youngsters might be found to have problems with binocular coordination, which can make reading and
other “near tasks” difficult and thus more likely to be avoided. He clarified, however, that vision
problems don’t cause attention-deficit disorder.

Vision screenings at school are not meant to be substitutes for comprehensive eye exams, but
many parents assume they are, Earley said. If a child passes such a screening, he said, parents “
think that means the child doesn’t have a vision problem.”

Even when school screenings do identify a problem, there’s often a lack of follow-up. Nearly 40
percent of school principals and nurses estimate that 25 percent or less of students referred for
follow-up vision care actually get that care.

It’s that kind of inaction that helped inspire last year’s opening of a comprehensive vision
clinic at Oyler Elementary School in Cincinnati, Earley said.

“We haven’t done a good-enough job explaining the impact that a visual deficit can have on a
child’s quality of life and educational development,” he said.